2018 Online Application FormApplicant InformationFull Name:* First Last Date of Birth:*01020304050607080910111213141516171819202122232425262728293031 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901daymonthyearGender:*E-mail Address:*Current Address:*Postcode:*Phone (Home):*Phone (Mobile):*Have you lived abroad for a period of more than 6 months in the last 3 years?*SelectYesNoIf YES, when did you return to the UK?Parent/Guardian InformationName of a Parent/Guardian:* First Last Current Address (if different to above):Parent/Guardian Postcode:Parent/Guardian E-mail:*Parent/Guardian Phone (Home):Parent/Guardian Phone (Mobile):Relationship to you:*Your Educational HistoryName of your current school/last school that you attended full time:*Date of leaving OR date projected to leave: (e.g. August 2018):*Address of the school named above:*Please give details about which courses you are studying and your projected or actual grades:Name e.g. FrenchLevel e.g. GCSEProjected GradeActual Grade1234567891011121314What You Want To StudyPlease choose 4 A-Level courses you would like to study, ranking them in order of preference. If you’re not sure, don’t worry – put down what you think you’d like to do and we can discuss this at interview:First Preference:*Choose SubjectBiologyChemistryPhysicsMathematicsFurther MathematicsComputer SciencePsychologyFrenchGermanSpanishEnglish LiteratureEnglish Lit & Language EconomicsGovernment and PoliticsGeographyHistoryPhilosophy and EthicsSociologyLawDrama and Theatre Studies BusinessPhysical Education & SportSecond Preference:*Choose SubjectBiologyChemistryPhysicsMathematicsFurther MathematicsComputer SciencePsychologyFrenchGermanSpanishEnglish LiteratureEnglish Lit & Language EconomicsGovernment and PoliticsGeographyHistoryPhilosophy and EthicsSociologyLawDrama and Theatre Studies BusinessPhysical Education & SportThird Preference:*Choose SubjectBiologyChemistryPhysicsMathematicsFurther MathematicsComputer SciencePsychologyFrenchGermanSpanishEnglish LiteratureEnglish Lit & Language EconomicsGovernment and PoliticsGeographyHistoryPhilosophy and EthicsSociologyLawDrama and Theatre Studies BusinessPhysical Education & SportFourth Preference:*Choose SubjectBiologyChemistryPhysicsMathematicsFurther MathematicsComputer SciencePsychologyFrenchGermanSpanishEnglish LiteratureEnglish Lit & Language EconomicsGovernment and PoliticsGeographyHistoryPhilosophy and EthicsSociologyLawDrama and Theatre Studies BusinessPhysical Education & SportYour Motivations And AspirationsPlease explain why you want to study these courses and any career aspirations you may have at this stage? (Max 75 words)*What attracts you most about applying for a place at Chapeltown Academy? (Max 75 words)*Please list any enrichment activities that you currently take part in AND any enrichment activities you would like the opportunity to try or continue with at the Academy:*RefereePlease provide details of a referee (most probably a school teacher) who we can contact for a reference:Referee Name:* First Last Referee Position:*Referee E-mail:*Referee Phone Number:Optional QuestionsWe are committed to meeting the needs of all learners. If consider yourself to have any learning difficulties or disabilities, please provide outline details:To assist with our equal opportunity monitoring, please let us know how you would describe your ethnic origin (e.g. White British):InformationIf you have any extenuating circumstances that you believe we should know about then please attach them to this form. Applications can be scanned and emailed to contact@chapeltownacademy.com or posted to Chapeltown Academy Admissions, Chapeltown Academy, Hydra Business Park, Nether Lane, Sheffield, S35 9ZX.Word Verification:SubmitReset